Do Perceptions of Risk and Quality of Life Affect Use of Hormone Replacement Therapy by Postmenopausal Women?

Dewey C. Scheid, MD, MPH, Mario T. Coleman, MPH, Robert M. Hamm, PhD

Disclosures

J Am Board Fam Med. 2003;16(4) 

In This Article

Abstract and Introduction

Background: Although the understanding of the health impact of hormone replacement therapy (HRT) is incomplete, even less is known about the attitudes, perceptions, and motivations of women faced with the decision to use HRT. The purpose of this study was to evaluate the relation between HRT use and women's perceptions of the risk and benefits associated with HRT use.
Methods: A written questionnaire was administered to 387 women, aged 45 years and older, responding to a health plan invitation for free bone mineral density screening. Women were asked to estimate the lifetime probability of developing breast cancer, uterine cancer, osteoporosis, and myocardial infarction when taking HRT and when not taking HRT. Women rated their quality of life in their current state of health, with breast cancer, with uterine cancer, with osteoporosis, and after myocardial infarction.
Results: HRT users perceived a greater risk reduction using HRT compared with HRT nonusers for osteoporosis (-34.9% vs -17.8%, P < .001) and myocardial infarction (-20.7% vs -8.4%, P < .001). HRT nonusers perceived a greater risk increase using HRT compared with HRT nonusers for breast cancer (16.5% vs 3.3%, P < .001) and uterine cancer (9.2% vs 0.6%, P = .004). HRT users estimated a greater quality-of-life reduction compared with HRT nonusers for osteoporosis (-31.0 vs -24.5, P = .006).
Conclusions: Regardless of whether they used HRT, women in this study overestimated their risk for all four diseases. HRT users perceived greater benefit and less risk using HRT than nonusers. The results of our study show that continuing efforts are needed to help women understand the risks and benefits of HRT.

The American College of Obstetricians and Gynecologists,[1] the American Academy of Family Physicians,[2] the American College of Physicians,[3] and the US Preventive Services Task Force[4] have previously recommended that physicians counsel postmenopausal women about their individual risks and benefits of hormone replacement therapy (HRT). Despite the widespread promotion of the benefits of HRT for preserving bone density,[4] most women did not accept HRT. A nationally representative survey of US women aged from 50 to 74 years old reported in 1999 that 59% of women without a uterus and 20% of women with a uterus used HRT.[5]

Although the understanding of the health impact of HRT use is still incomplete, there is even less knowledge about the attitudes, perceptions, and motivations of women faced with the decision to use HRT.[6] Women generally have started HRT for relief of menopausal symptoms.[7] Few nonusers of HRT have been aware of the increased risk of osteoporosis associated with lack of estrogen.[8] Concerns about the risk of breast cancer, uterine and endometrial cancer, menstrual bleeding, and other side effects have affected women's decisions to accept and continue HRT.[9] The purpose of this study was to evaluate the relation between HRT use and perceived risks and benefits associated with HRT use.

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